Individual
PATRICK DALE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
8258 ROCKVILLE ROAD, INDIANAPOLIS, IN 46214-0000
(317) 429-5400
(317) 429-5401
Mailing address
502 E MARKET ST, CRAWFORDSVILLE, IN 47933-1817
(765) 362-1500
(765) 361-8919
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001595
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000344411
ANTHEM
IN
05
—
200043740A
—
IN
01
—
201466872
TAX ID
IN
01
—
201466872100
CARESOURCE
IN
01
—
5288041
AETNA
IN
Enumeration date
11/13/2006
Last updated
01/07/2011
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